Started new job in outpatient IR. Many patients are sick, in pain, frustrated, and are with angry family members. I am trying to find the balance between keeping them happy and setting firm boundaries. I want to be kind, helpful, encouraging, professional while also protecting my own self. Manipulative and guilt tripping patient/ patient family members are difficult for me sometimes.
What are some tips for this? What do you say when a patient and/or patient family member is being completely unreasonable? What do you say when a patient family member is taking out their rage out on the world on to you?
I am asking for "go to" phrases that communicates empathy, understanding, and clearly states boundaries.
Happened to me with a drunk father complaining about an incident on another nurse's shift. Stay calm. I said, "Let me write everything down so I don't forget and make sure we address All of your concerns. I'll make sure our supervisor is aware." Let him him talk it out. Shake your head up and down as in understanding, but make no verbal agreements.
I make myself relax and turn on my calm voice. I don't play their game and never talk back. I listen and do not necessarily speak. They are not looking to hear from you and are not listening. Just let them vent first. Once they run out of steam they are ready to talk.
Remain empathetic, yet detached. Don't become part of the argument/fight. Keep reminding yourself it is not your problem.
Once I was the only nurse in a treatment setting. One of my patient was post TURP with a 3 way flush wide open. I had to empty it as fast as I could. While a family member just wanted her patient's stretcher off the carpet or on it. She started a loud tirade about someone needing to help her right away. I acknowledged her with my calmest voice and said: "Yes ma'am. As soon as I am done helping this gentleman.” I was not able to move the stretcher, but she stopped yelling.
If the behaviour is really out of control, look the person in the eye and tell them specifically what to stop doing: "I need you to stop screaming." "First, you need to let go of my lapels." If those things continue or if you're physically unsafe, then the next step is to call security.
It should never escalate if possible, for them to take hold of your lapels. I wish deescalation techniques were taught in nursing school. I would call security well before or during and not wait to be physically assaulted.
Sorry for the delay in responding but I really appreciate everyone's advice! Just one thing that kept coming up through people's responses that I wanna touch on: calling security. I learned this place doesn't have security to call.
I asked my boss about if things have ever gotten outta hand, or if they were to ever get outta hand, have they ever had to call 911 or something? Is there a safety plan for staff? Their answer was... unclear.
You should always call some sort of internal code and 911. People inside the building will reach you first. A lot of times, seeing people arrive will take care of the situation because the perp will back off. Don't hesitate if your admin tells you no or tries to discourage you from calling 911. For your own safety.
Oy. At least half of my last job was spent dealing with upset, enraged, family members. Especially the family members who felt slighted by the provider because no one ever talks to him. possible words:
"I can see that you're upset and I am definitely hearing everything that you're saying. Having a loved one in the hospital can be really stressful. What I hear you saying is ______. What can we do to solve these issues?"
Oy. At least half of my last job was spent dealing with upset, enraged, family members. Especially the family members who felt slighted by the provider because no one ever talks to him. possible words:
"I can see that you're upset and I am definitely hearing everything that you're saying. Having a loved one in the hospital can be really stressful. What I hear you saying is ______. What can we do to solve these issues?"
I have used those same lines... once I ask "what can we do to solve these issues?" 80% percent just say they want to see the doctor, even if they've already been updated and have seen the doctor. and then all I can do is tell them that I will reach the doctor, which I then do, however, often at that point, the MD is caught up in another case, or with another patient, or involved in a consult, or talking to family members about their loved ones recent death, or dealing with an emergency, or simply doesn't want to deal with the patient/family anymore and tells me that he will get there when he can, and sometimes the MD just goes home. I often don't know where theyre at or what they are doing or why they do not respond. I don't have a special doctor detector on hand just because I am a nurse.
The general population doesn't seem to realize that just because I am a nurse does not mean I have the ability to summon a MD at random. I am not a magician for God's sake. People are people and people do whatever they want. For some reason, many patients believe that they should be able to access a specific MD at any time. Often the patients I deal with operate with that belief and mindsent and forget and/or do not care that at the end of the day the nurses, MDs, and all staff are humans, too. No one can FORCE any other human to do something. Obvs I don't say that out loud. But it is the reality of my workplace and prior workplaces.
Then I get yelled at and told what a crappy nurse I am. Sometimes called colorful names, and blah blah blah, complaints are made, etc. So that's where my frustration lies. I am polite, empathetic, offer alternatives (such as, reaching the MD with their questions later with the facility phone number to coordinate a best time to chat and follow up with MD. I even offer suggestions such keeping a notepad and pen and allow this time to write down your questions so that everything will be covered and so at end of day you will get all of your answers). Sometimes it works? IDK. I work with a lot of post transplant and ESRD patients and not to generalize but the mentality of the patients is just.... different. Mostly theyre hyper anxious and without a real good emotional intelligence level, you will end up with a patient who gets angry or upset or threatening or all of the above. So, am always careful with my words, tone of voice, attentive, and very intentional.
Usually, they need to yell, and I'm the one in front of them. It could be anxiety, aftereffects of an adrenaline rush, the situation, conflict with someone else, nervous energy from a wait...you name it. some people are very on/off with anger, no middle ground of just irritation.
If they have the energy to yell, I let them get that energy out, just be there. As things simmer down, only then can they think clearly enough to identify problems we can fix together. I don't mind yelling, but I'm not comfortable with folks standing within arms reach and yelling, or any physical contact. Leave at that point.
Working the ER we get a lot of complaints about the wait. In that case I agree over and over that its been a long wait, things "should" be done sooner, and yes I understand that Walmart will close soon. I mention the doc working on other patients just once, and alert waiters if the the doc just got pulled in to a trauma. Really, they don't care, and you can avoid an argument by finding a way to agree.
If they have the energy to yell, I let them get that energy out, just be there.
You're a better person than I am. I spent my childhood and a good part of my adult life being the emotional and physical punching bag for people who were unable to keep a handle on their emotions and I'm not about to do it again at work. They don't pay me enough.
If they want me to help them they can do it without yelling and I'm happy to be there for them.
Elodea Tiaga
7 Posts
Happened to me with a drunk father complaining about an incident on another nurse's shift. Stay calm. I said, "Let me write everything down so I don't forget and make sure we address All of your concerns. I'll make sure our supervisor is aware." Let him him talk it out. Shake your head up and down as in understanding, but make no verbal agreements.